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Replace diet discussions with focus on mindful eating
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In this issue, Susan Weiner, MS, RDN, CDE, CDN, FAADE, talks with Michelle May, MD, and Megrette Fletcher, MEd, RD, CDE, about mindful eating for diabetes self-management. Balanced eating and consistent intake of carbohydrates is a challenging message to communicate to clients during a brief office visit. Even with time, a complete diet overhaul just does not work. Shifting the conversation away from restrictive diets toward mindful eating helps move the relationship with food from adversarial to nourishing.
We hear a lot about ‘mindful eating’ these days, but what is it?
May and Fletcher: The origins of mindful eating come from mindfulness, which is choosing to be aware of the present moment without judgment. After all, the present moment is where all decisions are made. Instead of telling you about it, experience mindfulness for yourself right now. Stop reading for a moment and pay attention to your body in your seat. Simply notice how it feels. What are you aware of? If you notice you’re uncomfortable, what could you change to feel more comfortable? Could you shift positions? Get a drink? Grab a blanket? That bit of awareness opened you up to several options for taking care of yourself.
How can mindful eating help with diabetes self-management?
May and Fletcher: Our diet-crazed culture often encourages restriction of certain foods or macronutrients, which isn’t health promoting or sustainable and may trigger disordered eating patterns. With diabetes, people may become self-critical and avoidant. They live in the past (I should have ...) or the future (what if ...) or distract themselves with TV, work or food. The tendency to overlook, and even distrust, their present experience prevents them from using the most current information to make decisions. Further, the diet-culture narrative is that health is dependent on a number on the scale, which becomes a distraction from the many day-to-day decisions they make that can affect their blood sugar.
On the other hand, mindful eating for diabetes care focuses on awareness, not restriction, as the critical skill people need for long-term diabetes self-management. Mindful eating teaches us to pause and become curious about our physical sensations, thoughts and feelings, giving us a way to become conscious about our underlying beliefs. For example, if a person notices that they feel overly full and uncomfortable after eating, they might realize that they felt compelled to clean their plate to avoid wasting food. They can then use that feedback to help them with future decision-making. If they also choose to check their blood sugar, they’ll get additional feedback about the effect of eating past the point of satiety.
We utilize a model called the Mindful Eating Cycle to help clients become aware of the hundreds of eating decisions they make every day. The model consists of six decision points that bring awareness to decision-making, planning and problem-solving. As a health care provider, you can use the model to guide your questions about eating, physical activity and self-care.
Why do I eat? What drives my eating at any given time? As a provider, you might ask, “Have you ever wondered why you’re eating in the first place?”
When do I want to eat? Counseling your clients to use mindful eating requires you both to become curious, such as, “Are there times you find yourself reaching for food when you aren’t hungry?”
What do I eat? If your client affirmed that they sometimes eat out of habit or for social or emotional reasons, you could ask, “At those times, what types of foods do you seem to gravitate toward?”
How do I eat? Clients might describe their eating as feeling “out of control,” sneaking, mindless or guilt-inducing, providing insight into their relationship with food.
How much do I eat? You might ask, “Do you often feel overly full or uncomfortable after eating? Have you noticed a connection with your blood sugar?”
Where do I invest my energy? That is, where does the fuel I’ve consumed go? People with diabetes often feel that they should constantly focus on what they are eating and how much they are exercising. The true purpose of diabetes self-management is lost: to live a full and vibrant life.
The Mindful Eating Cycle provides the necessary structure for replacing ineffective thoughts, beliefs and behaviors with a flexible, sustainable approach that is far more transformational than any rigid food plan.
How can mindful eating help with diabetes self-management?
May and Fletcher: There is a difference between being “in control” vs. being “in charge.” Trying to control one’s eating is temporary and energy-consuming. It relies on willpower and micromanagement that is quickly sabotaged by an endless list of variables, leading to the opposite outcome: feeling out of control.
Your client may vacillate from one extreme to the other, either feeling in control and trying to follow the rules perfectly, or feeling out of control, mindless of eating, blood sugar and overall diabetes care.
On the other hand, mindful eating guides your clients to be in charge and recognize their physical state, thoughts, feelings and the effects of their choices. They learn to trust their body wisdom to help them make conscious, intentional decisions, no matter what emotional or environmental cues make it difficult to stay in control.
Mindful eating makes it possible for people with diabetes to live free of guilt and deprivation while still managing their blood glucose. It isn’t about being perfect; it’s about being realistic and accepting that no matter where they are or what they’re doing, they need to eat and manage their blood sugars.
We like to say that mindful eating puts the “self” in diabetes self-management because, after all, helping your clients discover how to be in charge of their diabetes is the goal of self-management.
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Megrette Fletcher, MEd, RD, CDE, is an author, registered dietitian, certified diabetes educator and co-founder of The Center for Mindful Eating. She is co-author with Michelle May, MD, of Eat What You Love, Love What You Eat with Diabetes.
Reach her at megrette@megrette.com . - Michelle May, MD, is the founder of Am I Hungry? Mindful Eating Programs and Training and the author of the Eat What You Love, Love What You Eat book series. Reach her at mmay@amihungry.com or www.AmIHungry.com.
- Susan Weiner, MS, RDN, CDE, CDN, FAADE, is the 2015 AADE Diabetes Educator of the Year and author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com.
Disclosures: Fletcher reports she receives royalties from Am I Hungry LLC and Skelly Skills LLC and is owner of Megrette.com, WN4DC and WN4DCsymposium.com. May reports she is owner of Am I Hungry? Mindful Eating Programs and Training. Weiner reports she is a clinical adviser to Livongo Health.